Job title: Patient Access Representative & Insurance Specialist ( Privia Infusion Center)
Company: Privia Medical Group – Gulf Coast
Job description: Company Description** This is an onsite, in person vacancy**We are a group of providers united by our clinically integrated, high-performance network and shared belief that physician autonomy is key to improving healthcare. As a physician-led medical group, we provide the tools, talent, and technology that enable you to improve patient care and your practice’s economic outcomes. We remove administrative work to help you transition to and thrive in value-based care so you can focus on patients, not paperwork and policy.Job Description**THIS VACANCY IS A PART TIME POSITION 8-10 HOURS PER WEEK**Overview of the Role:The Patient Access Representative – Insurance Specialist (PARIS) has responsibilities across various business units of Privia Medical Group Gulf Coast (“PMG-GC”) as assigned by PMG-GC Management. Duties will generally conform with the below descriptions and fall into the areas of patient benefits determination and verification and revenue cycle management responsibilities.Duties will vary somewhat with each specific assignment and will be outlined prior to assignment. As of the date of this job description, the below are the outlines of some specific current and potential responsibilities.Infusion Center Ancillary Job Duties:The Patient Access Representative is responsible for all communications with the patients of the infusion center regarding their insurance and/or patient account with Privia Medical Group Gulf Coast, as well as, all communications with third party payers regarding benefits and/or payment of services. Duties include but may not be limited to:Obtain prior authorization for infusion treatment. Prior Authorizations must be submitted to insurance for approval within 2 business days of receipt request.Enter or scan all actions related to the patient’s account into an electronic medical record including the prior authorization forms submitted to insurance companies when they are faxed for authorization.Obtain physician referral prior to infusion.Review upcoming appointments 1, 7 and 30 days before scheduled services to obtain benefits verifications and referrals for infusion.Collect deposits, deductibles and/or co-pays from the responsible party. Work with patients to make financial arrangements.Respond to patient requests regarding information on their account. Explain financial policy and procedures as needed.Respond promptly to payer (insurance company, employer, etc.) calls and correspondence related to patient services and claims.Work insurance claims to ensure prompt and accurate billing. Work to resolve coding or billing errors in order to effect accurate reimbursements and minimize patient liability.Complete all necessary forms and medical documentation, as necessary, for copay programs available through the drug companies. Submit required forms and documentation for prompt payment.Coordinate with other infusion center staff to seek patient account resolutions.Follow up on unpaid and underpaid claims to effect complete reimbursement by the payer/patient. Resubmit or correct and submit claims or submit appeals, as required.Audit all patient account transactions for accuracy and resolve any outstanding issues. Identify and correct billing errors.Communicate with clinical staff and physicians regarding outstanding issues related to patient accounts.Use approved collection correspondence and/or calls to patients to effect collection ofpatient responsibility.Audit all patient credit balance accounts for resolution.Make recommendations to the manager concerning accounts to be passed to third-party collection or to be adjusted as uncollectible.Privia Care Center Job DutiesThe Patient Access Representative – Insurance Specialist may be assigned special projects designed to help PMG-GC care centers with specific issues related to claims production and/or collections, benefits verification, staff education or other revenue cycle management related issues. The PARIS will work closely with and under the direction of the Privia Health Gulf Coast Director of Revenue Cycle Management on the scope and details of such assignments.Complete the “Margin Analysis & Allowables” report for infusion center drugs no later than 23rd of the month preceding a new calendar quarter review, as actual reimbursements are received in each quarter, to determine if drug costs and reimbursements are aligned with projections.Audit all patient account transactions for accuracy and resolve any outstanding issues.Identify and correct billing errors.Check daily the payments posted by Athena for accuracy.Contact patients after authorizations are obtained to explain benefits and coordinate payments prior to the first infusion appointment.Perform end of the month inventory of drug supplies.Order office supplies and scan packaging slips to appropriate departments.Participate in educational and developmental activities.Attend meetings as requested.Perform other duties as directed by the supervisor.QualificationsAt least five years comprehensive experience in a medical/physician office environment.At least five years medical collections experience.At least three years working knowledge of CPT and ICD-10 coding standards.Comprehensive knowledge of clinical registration, patient accounting, billing, reimbursement and third party payer/managed health care procedures and practices.Knowledge of clinical departments and operational relationships.Knowledge of and ability to use CPT and ICD-10 coding standards.Understands advanced level of medical office terminology.Skilled in analyzing accounting, billing, coding, and third party payer reports.Ability to perform mathematical computations and compute ratios and percentages.Skilled in defining problems, collecting data, interpreting billing information.Skilled in using medical software computer applications.Ability to organize work for the highest level of efficiency.Ability to communicate clearly and be self motivated.Ability to develop and maintain positive, effective relationships with patients and staff.Education/Certificate/LicenseHigh School Diploma or GED; some college preferred.The hourly compensation for this vacancy is $28 per hour.Additional InformationAll your information will be kept confidential according to EEO guidelines.#LI-DNIPrivia Health is committed to creating and fostering a work environment that allows and encourages you to bring your whole self to work. Privia is a better company when our people are a reflection of the communities that we serve. Our goal is to encourage people to pursue all opportunities regardless of their age, color, national origin, physical or mental (dis)ability, race, religion, gender, sex, gender identity and/or expression, marital status, veteran status, or any other characteristic protected by federal, state or local law.
Expected salary: $28 per hour
Location: Houston, TX
Job date: Fri, 25 Apr 2025 22:55:45 GMT
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Patient Access Representative & Insurance Specialist ( Privia Infusion Center)
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